Drug Reaction Case Study
Have you ever given a drug to a patient and found that they were actually allergic to it? What did you do?
I treated a 45 year old female with severe back pain. The patient states it started while trying to move a bookshelf. Good motor/sensory by all four limbs. Severe pain in the lower lumber region, with associated sciatica. The Patient states only known drug allergy – Codeine. 5mg IV morphine was administered and the Patient states great improvement in pain. After 2 minutes, the Patient states severe itchiness and pain to R arm (the one with the cannula). Within another minute, the Pt developed a mildly swollen arm, widespread urticaria to the arm, and then welts following the veins where morphine had been administered. The patient’s Airway, Breathing and Circulation were unaffected. The swelling and urticaria was confined to the R arm only. The IV was flushed with saline and P/O Fenofexodine (Telfast) was given for its antihistamine properties.
This slowly reduced the allergic reaction and no other medications were administered.
Would you have considered adrenaline? What else could a paramedic have done? Would they do anything differently in hospital? Would you have considered a lower dose of Morphine because of the allergy to codeine?